The idea of narrative is becoming recognized as basic to
understanding humans and culture. Philosopher
Alisdair MacIntyre writes, "[W]e all live out narratives in our lives" and "we
understand our own lives in terms of the narratives that we live out." (MacIntyre,
1981) .
The default mode of the brain according to Washington University neuroscientist
Raichle is to make up stories. It is
what we do easiest. It is what burns the
least amount of glucose. It is,
according to neuroscientists and artificial intelligence experts Shank and
Abelson, the template for human memory.
We humans actually think more in terms of verbs than in nouns. When we see something, we want a story about
it. We want to know what it does or what
it can be used for.

What is narrative?
The shortest narrative consists of two action clauses and an orienting
clause. I like to tell a short story
that one of our clients told. She said, "One
time I killed my boyfriend, but then he came back to live and tried to kill me.
That was when we were living in Georgia
and I was dealing coke." This short
story tells so much. It conveys the
essence of a character, of a human being positioning herself to be seen in a
certain light. It contains values and
emotions. It conveys a richness of
understanding far beyond its mere words.
It is a work of social art, complexly rich and detailed.

University of Auckland Professor Brian Boyd argues that our
big brains arose to do story. Brain
evolved to do story because story worked.
Story worked because it is the most efficient way to store massive
social information as illustrated above.
Each of us can, apparently, know about 500 other people. The amount of information we need to negotiate
relationships with these others is massive.
We retain it in the form of stories.

Thus, narrative medicine means an understanding of health
and disease for humans, that is grounded in the stories humans live out in
their lives and the stories that we understand about our lives which give our
lives meaning and purpose. Whatever we
do only makes sense in the context of being grounded in a story or two. When you recognize that I have a belief, that
belief only makes sense if I tell about the experiences that led me to form
that belief. This belief rests upon
experiences that led to certain conclusions that are stored in a narrative
template.

Probably you wonder why this excites me so much! I would answer, "because it bridges my
indigenous parts with my non-indigenous parts.
In growing up, I learned that everything that mattered was a story. If my grandparents had something important to
tell me, they would tell me a story. I
was expected to interpret the story, to make sense of the story and to grasp
what they wanted me to know. I learned
that "all there is, is story". In
Lakota, our personhood is the synthesis or integration of a swarm of stories
that surround us called the nagy. These stories consist of all the stories
that form us or that we have told or are enacting as we move about in the
world. This nagy also consists of all the tellers of those stories. We are forever embedded in each other's nagy's.

To bring that into the practice of medicine, it means that
illness is embedded in the stories we are performing and that are performing
us. There is a biological story about
how we are organisms who are born, live, wear out, and die. Our lives are finite. Within that finitude, however, are multiple
social stories which interact with the "how long do I have to live story". Another story tells us that some events
within our lives appear to be random, meaning that I can't make sense of them. I can't place them within a story. However, if I find the stories that people
are telling and that are told about them, often their illnesses are illuminated
in some way. The illnesses make more
sense.

David
B. Morris of the University of Virginia, writes that narrative is above all a
form of knowledge (Morris, 2005) . In this view, narrative knowledge complements
and differs from traditional "logicoscientific" knowledge (Charon, 2001) .
For Charon, narrative knowledge is less of a product than a tool. It is "what one uses to understand the
meaning and significance of stories through cognitive, symbolic, and affective
means." Its identifiable properties --
beginnings, middles, endings, characters, conflicts, and turning points -- for Morris
are more descriptive than definitive.

Narrative
comes from the Latin word, narrare,
which means "to tell" and refers to various forms of telling. Philosopher Richard Kearney writes that, "[N]o
matter how distinct in style, voice, or plot, every story shares the common function
of someone telling something to someone
about something" (Kearney, 2002) . For Morris, these tellings include the
gamut from fragments of discourse to ancient formulaic epic poems like the Iliad or The Odyssey to cryptic post-modern novels. Other scholars go further than Charon to
argue that all knowledge, even the conventional declarative knowledge of modern
medicine is narrative because all knowledge is embedded in theory which is a
story about how the world is supposed to work.
These stories have characters in the form of biological entities or
molecules, they have plot in the sense of operations that take place upon these
entities (enzymatic reactions, flows of ions, passage of molecules across
membranes). They have implicit values
such as preserving the life of the organism.
Even mathematical proofs can be seen as narratives. Some neuroscientists see human identity and
the operation of human consciousness as narrative (Fireman, McVay, & Flanigan, 2003) .

Narrative
is not strictly verbal. It is visual,
bodily, kinetic, musical, and mixtures of all these. Choreographed dances are stories, such as American Spring as are musicals like Oklahoma. For Morris, stories also hold the negative,
what cannot be told, the gaps, silences, and what cannot be said. Stories always contain a matrix of choices --
what is valued, what is marginalized, and what is excluded. Within medicine, narrative reminds us that
illness is always caught up in stories involving families, jobs, cultures, and
meanings and is not limited to the simply biological rendering, which we call "the
natural history of the disease". Indeed,
I suggest that illness is without natural history because it is always affected
by human affairs -- by people's search for meaning and happiness, by the
relationships in which they find themselves, and by the broader stories of
culture. Biology is not an island
unaffected by the sea in which it swins.

Lewis Mehl-Madrona graduated from Stanford University School of Medicine and completed residencies in family medicine and in psychiatry at the University of Vermont. He is the author of Coyote Medicine, Coyote Healing, Coyote Wisdom, and (more...)